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Coding Test

Everything you need to study for the Coding Test

The amount that an insured person must pay for each office visit is called the copayment. TRUE
PPO is the abbreviation for plan/provider options. FALSE
A primary care physician is also referred to as a gatekeeper. TRUE
Adjudication is the process that third-party payers follow to determine payments for claims. TRUE
Diagnosis codes are used to record the patient's services and treatments on encounter forms. FALSE
EOB is the abbreviation for explanation of benefits. TRUE
Medically necessary treatments are appropriate and provided in accordance with generally accepted standards of medical practice. TRUE
New patients have not received any services from the provider, or another provider of the same specialty in the same practice,within the past three years. TRUE
The patient ledger is a record of all the charges and payments on a particular patient's account. TRUE
COB is the abbreviation for calculation of benefits. FALSE
A walkout receipt is given to patients who have made a payment after an encounter. TRUE
ERA is the abbreviation for electronic remittance advice. TRUE
In legal terms,abusive actions improperly use other/s resources. TRUE
Billing Medicare for the unnecessary use of a laboratory procedure is an example of abuse of government resources. TRUE
Facts that are privileged information must be kept confidential. TRUE
An implied contract has the same legality as a written contract. TRUE
Fraud is deception with intent to benefit from the fraudulent behavior. TRUE
Original documents from the patient medical record are not released. TRUE
Fax machines provide fast,efficient,and secure transmission of documents. FALSE
The annual addenda to the ICD-9-CM list new,revised,and deleted diagnostic codes. TRUE
In the ICD-9-CM,NEC is the abbreviation for not elsewhere classified. TRUE
Diagnosis codes must be selected by physicians. FALSE
If the physician's diagnostic statement for an encounter states "rule out suspected aortic neoplasm," a code for the carcinoma is used to report the condition. FALSE
When a patient has a closed fracture,the broken bone has broken through the skin and created an external wound. FALSE
All of the patient's conditions,including diseases or illnesses no longer active or present,must be considered in selecting the correct diagnosis code for an encounter. FALSE
In CPT-4 the term "consultation" describes services that a provider performs at the request of another provider after which the patient is returned to the requesting provider's care. TRUE
In CPT-4,evaluation and management codes cover anesthesia and most surgical procedures. FALSE
Fragmented billing refers to the incorrect seperate reporting of CPT-4 procedure codes that should be bundled under a single code. TRUE
HCPCS is the abbreviation for Health Care Financing Administration Common Procedure Coding System. FALSE
In the CPT-4 code 01320-P3 the "P3" is an example of a physical status modifier. TRUE
If a procedure that is designated a seperate procedure in CPT-4 is performed for a different purpose than ususally done it may be reported. TRUE
CPT-4's section guidelines appear at the end of each section. FALSE
CPT-4 codes have four digits FALSE
CPT-4 codes for initial hospital care can be reported for every 24 hours that a patient is hospitalized. FALSE
When a physician treats complications or recurrences that arise after surgery,these services are reported separately. TRUE
The term "code linkage" refers to the connection between a service that is provided and the patient's condition or illness. TRUE
The term "external audit" may refer to an audit conducted by a consultant that the medical practice has hired. TRUE
The Medicare Carriers Manual contains the code edits used by the Medicare program to screen reported procedure codes. FALSE
Retrospective audits are conducted by HCFA. FALSE
A provider who is found guilty of fraud and abuse against the Medicare program can be excluded from further participation as a provider in all government-sponsored health care programs. TRUE
In the United States,rising medical costs are due to: a:increased spending on drugs b:increased use of alternative treatments c:advances in technology d:all of the above D: All of the above
A capitated rate is called a: a:copayment b:coinsurance payment c:retroactive payment d:prospective payment D: Prospective payment
Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer? a:payments b:risk c:services d:the premium B: Risk
Patients who enroll in an HMO may use the services of: a:only HMO network providers b:any affiliated provider c:only out-of-network providers d: any provider A: only HMO network providers
Patients who enroll in a point-of-service type of HMO may use the services of a:only HMO network providers b:any affiliated provider c:any provider d:HMO network or out-of-network providers D: HMO network or out-of-network providers
The four models of health maintenance organizations are: a: staff,group,IPA,and POS b:staff,group,IPA,and PPO c:staff,group,IPA, and PCP d: staff,group,network, and IPA A: staff,group,IPA,and POS
Which of the following charachteristics is most important when medical insurance specialists work with patients' records and handle finances? a:able to work as a team member b:honesty and integrity c:knowledge of medical terms d:communication skills B: honesty and integrity
When medical insurance specialists work with patient billing programs,they need a:computer skills b:communication skills c:knowledge of anatomy d:flexibility A: computer skills
The title of Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-based (CCS-P) is awarded by a:AAMA b:AAPC c:AMT d:AHIMA's Society for Clinical Coding D: AHIMA's Society for Clinical Coding
The statement that "coding professionals should not change codes,so that meanings are misinterpreted" is an example of: a:professional ethics b:professional services c:professional etiquette d:personal ethics A: professional ethics
The employment forecast for well-trained medical insurance and coding specialists is: a:decreasing opportunities b:opportunities staying the same as today c:increasing opportunities d:none of the above C: increasing opportunities
Which of the following is the correct order for documentation? a:diagnosis,treatment,history and exam,and CC b:treatment,CC,history and exam,and diagnosis c:history and exam,diagnosis,CC and treatment d:CC,history and exam,diagnosis,and treatment D: CC,history and exam,diagnosis,and treatment
Which of the following represents the correct format for recording dates on patient information and claim forms? a:DD/MM/YY b:MM/DD/CCYY c:MM/DD/YY d: CCYY/MM/DD C:MM/DD/YY
In which of the following claims-processing steps is the payer's decision about paying claims made? a:provider reimbursement calculations b:claims transmission c:claims preparation d:adjudication D: adjudication
Libel refers to which type of information? a:written b:oral c:confidential d:none of the above A: written
A court order to appear,testify,and bring specified documents or items is a: a:respondeat superior b:subpoena duces tecum c:subpoena d:none of the above B: subpoena duces tecum
Information about a patient must be kept confidential because: a:it is the physician's duty to do so b:the information is potentially harmful to the patient c: both a and b d:neither a nor b C: both a and b
The cross-reference See in the ICD-9-CM means that the coder: a:may look up a related term(s) that follows b:must refer to the term that follows c:either a or b d: neither a or b B: must refer to the term that follows
The term Blackfan-Diamond anemia is an example of a(n) a:etiology b:acute condition c:eponym d:combination code C: eponym
How many codes does the entry Cataract,myotonic 359.2[366.43] in the ICD-9-CM's Alphabetic index require? a: one code b:two codes c:three codes d:four codes B: two codes
A condition that arises because of an injury or illness in the patient's medical history is called a(n) a:adverse effect b:manifestation c:comorbidity d:late effect D: Late effect
An adverse effect is the result of: a:intentional poisoning b:unintentional poisoning c:traffic accident d: signs and symptoms B: unintentional poisoning
What is the main term in the diagnostic statement"localized salmonella infection,unspecified"? a:localized b:salmonella c:infection d:unspecified B:Salmonella
The diagnostic statement is"patient has found a mass in the upper quadrant of the left breast;carcinoma is suspected and an immediate workup is scheduled" What main term is coded? a:mass b:carcinoma A: Mass
In the diagnostic statement"tuberculous rheumatism" which is the main term? a: tuberculous b:rheumatism c: either a or b C: either a or b
In CPT-4,what procedure is bundled with the arthroscopy in the following entry? 29860 Arthroscopy,hip,diagnostic with or without synovial biopsy a: a diagnosis b:the hip site c:a synovial biopsy d: none of the above C: a synovial biopsy
Durable medical equipment (DME) such as wheelchairs covered by the Medicare program are reported using a:ICD-9-CM codes b: CPT-4 codes c: HCPCS codes d:local Medicare carrier codes C: HCPCS codes
Under CPT-4's definition,after a referral,who takes responsibility for the patient's care? a: the physician who referred the patient b:the physician to whom the patient is referred c:either a or b d: neither a nor b B: the physician to whom the patient is referred
Routine annual physical examinations are reported using CPT-4's a:Office Services codes b: Preventive Medicine Service codes c:Critical Care Service Codes d: Consultation codes B:Preventative Medicine Service Codes
What is required of the physician in order to report the professional component of a CPT-4 code from the Radiology section? a:reading the radiological examination b:writing a report of interpretation c: both a and b d: neither a or b C: both a and b
If a payer judges that too high a code level has been assigned by a practice for a reported service,the payer may a: reduce the fee attached to the reported code b:downcode the reported procedure code c:either a or b d: neither a nor b B: downcode the reported procedure code
What type of audit is performed internally before claims are reported? a:accreditation audit b:routine payer audit c:retrospective audit d:prospective audit D: prospective audit
What document is received before a retrospective audit of a claim is performed? a:NCQA guidelines b: explanation of benefits from the payer c:Medicare Carriers Manual d:Medicare CCI B: Explanation of benefits from the payer
Which member of the medical practice is ultimately responsible for proper documentation and correct coding? a:registered nurse b:medical coder c:physician d: all of the above C: physician
Some possible consequences of inaccurate coding and incorrect billing in a medical practice are: a:denied claims and reduced payments b:prison sentences c:fines d:all of the above D: all of the above
A provider billing the Medicare program for a cosmetic procedure intended to enhance the patient's appearance is a possible situation of a: downcoding b:upcoding c:prospective billing d: lack of medical necessity A: downcoding
Which is not a characteristic of correctly linked codes? a: the procedure codes match the diagnosis codes b:the procedure codes have correct modifiers c: the procedures are not elective,experimental d: the procedures are provided at an approp. level B: the procedure codes have correct modifiers
An important part of a compliance plan is commitment to keep both physicians and medical office staff current by providing a: external audits b:ongoing training c:OIG Fraud Advisories d: practice work plans B: ongoing training
A medical practice's signature log shows the legal name,credentials,and signature of each person who a: is employed by the practice b:makes entries in patient medical records c:handles the patient billing system d: communicates with third-party payers B: makes entries in patient medical records
The statement,"All entries in the medical record must contain the author's identification" is from the NCQA's a:Compliance Plan b:Work Plan c:Documentation Guidelines d:Overpayment Policy C: Documentation Guidelines
A policyholder's _________ include the spouse and children. Dependents
Capitation is a fixed prepayment to a provider for all necessary, _______________ medical services. Contracted
Under indemnity plans,the ________ is the amount that the insured must pay before benefits begin. Deductible
Verifying patient information in large medical practices is a task performed by ____________. Medical Insurance Specialist
Entries in a patient's medical record should be _________ or ________ by the responsible provider. Signed or Initialed
____________ contain all facts,findings,and observations about patient's health history. Medical Records
SOAP is a format for patient medical _____________. Documentation
Entries in patient medical documentation may be filed in either ascending or descending ____________ order. Chronological
Which parent's insurance plan is primary for a child is decided by following the______________. Birthday Rule
The universal claim form is the _______________. CMS 1500
__________________ means using the care and expertise that under the circumstances could be reasonably expected of a medical professional with similar experience and training. Medical Standards of Care
The OIG, or ____________________, is responsible for enforcing laws relating to medical insurance fraud and abuse. Office of Inspector General
A physician's description of the main reason for a patient's encounter is called the diagnostic ________________. Statement
When diagnosis codes are reported, the code for the _______________ diagnosis is listed first,followed by the current coexisting conditions. Primary
In the CPT-4 entry 29909 Unlisted procedure,arthroscopy the words "Unlisted procedure,arthroscopy" are referred to as the ____________. Descriptor
In CPT-4,some codes have both a technical component and a _____________ component that represents the physician's skill,time, and expertise. Professional
Codes in the Anesthesia section of the CPT-4 are reimbursed according to ______________. Time
A complete procedure for codes in the Pathology and Laboratory section of CPT-4 includes performing the test and analyzing and _______________ on the test results. Reporting
The Medicare Correct Coding Inititive lists procedures that cannot be billed together for the same __________ on the same ____________. Patient/ Day
In addition to facilitating high quality patient care,an appropriately ______________ medical record serves as a legal document to verify services provided. Documented
Created by: mannj29